Category: Curator- Job Hunter

Clipped from: https://www.learn4good.com/jobs/charlotte/north-carolina/info_technology/1622306284/e/

Position:  Senior Data Analyst (Medicare/Medicaid)
 

Type of

Requisition : Regular

Clearance Level Must Be

Able to Obtain: None

Job Family: Data Analysis

GDIT is searching for Senior Data Analyst to join our growing team.

You will support an exciting new program focused on identifying vulnerabilities in Medicaid, Medicare and the Marketplace. The position will focus on reviewing and analyzing publicly available data related to Medicaid, Medicare, and/or Marketplace exchanges. Our work depends on a Senior Data Analyst joining our team to support our customer, Center for Medicare and Medicaid Services (CMS) activities. At GDIT, our people are er of everything we do.

As a Senior Data Analyst supporting CMS Vulnerability Management Contract.

You will be trusted to work on specific technology and data science tools to identify vulnerabilities within CMS’ programs in Medicare, Medicaid, and Marketplace. In this role, a typical day will include:

• Collaborating with CMS Center for Program Integrity (CPI) to effectively identify and target specific healthcare vulnerabilities to detect and prevent FWA
  
• Extract qualitative and quantitative relationships (i.e., patterns, trends) from large amounts of publicly available data using SAS, SQL, R, Python, or other statistical tools
  
• Gather and organize information for use in supporting decision-making process
  
• Collect, manipulate, analyze, evaluate, and display data using visualization tools
  
• Perform data analysis and create data summaries using descriptive statistics
  
• Implement open-ended data merges, data analysis plans, and perform complex data manipulation and reporting tasks
  
• Develop, write, and present detailed technical solutions to solve open-ended business problems to technical and non-technical audiences
  

Required Skills:

 

• Bachelor’s degree and 8+ years related experience (or equivalent combination of education and experience such as a Masters and 6+ or no degree and 12 years)
  
• Medicare, Medicaid and/or Healthcare Marketplace experience
  
• Superior skills conducting statistical and mathematical modeling and analysis using SAS software
  
• Superior skills using SQL for data manipulation purposes
  
• Experience developing and presenting solutions to complex, open-ended problems
  
• Experience proactively identifying and working collaboratively with stakeholders to resolve data anomalies, data quality, and compliance issues in administrative data
  
• Experience matching and merging disparate data sets
  
• Experience using MS Excel and PowerPoint for analysis and presentation of results
  

Desired

Skills:

 

• Experience with fraud detection
  
• Experience using data visualization tools such as Tableau
  
• Experience conducting health care related research and analytics
  
• Superior customer service skills working proactively and collaboratively with federal or state research, compliance, and policy staff and stakeholders to implement and enhance internal and external management reports and public-facing data analysis tools and data sets
  
• Superior multi-tasking and organization skills. Must manage multiple simultaneous projects and prioritize assignments and tasks, accordingly, remaining flexible to changing priorities and new initiatives
  
• Superior written and verbal skills. Must write succinctly and clearly and explain complex situations in plain English to technical and non-technical audiences
  

#CMSVulnerability Management

#GDITHealth Systems

#GDITPriority

COVID-19 Vaccination: GDIT does not have a vaccination mandate applicable to all employees. To protect the health and safety of its employees and to comply with customer requirements, however, GDIT may require employees in certain positions to be fully vaccinated against COVID-19. Vaccination requirements will depend on the status of the federal contractor mandate and customer site requirements.

We are GDIT. The people supporting some of the most complex government, defense, and intelligence projects across the country. We deliver. Bringing the expertise needed to understand and advance critical missions. We transform. Shifting the ways clients invest in, integrate, and innovate technology solutions. We ensure today is safe and tomorrow is smarter. We are there. On the ground, beside our clients, in the lab, and everywhere in between.

Offering the technology transformations, strategy, and mission services needed to get the job done.

GDIT is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status, r protected class.

Clipped from: https://www.glassdoor.com/job-listing/case-manager-rn-medicaid-molina-healthcare-JV_IC1134737_KO0,24_KE25,42.htm?jl=1008221028529&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

JOB DESCRIPTION

Case Manager (RN) – Medicaid

For this position we are seeking a (RN) Registered Nurse who lives in MICHIGAN and must be licensed for the state of MICHIGAN. We cannot accept out of state licensure.

This is a telephonic case manager role, managing our Medicaid and Marketplace population

WORK SCHEDULE: Monday thru Friday 8:30AM to 5:00PM /

This is a Remote position, but will require the flexibility to go into Troy, MI location for meetings and training

Home office with internet connectivity of high speed required.

Job Summary

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

Completes comprehensive assessments of members per regulated timelines and determines who may qualify for case management based on clinical judgment, changes in member’s health or psychosocial wellness, and triggers identified in the assessment.

Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member’s support network to address the member needs and goals.

Conducts face-to-face or home visits as required.

Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.

Maintains ongoing member case load for regular outreach and management.

Promotes integration of services for members including behavioral health care and long term services and supports/home and community to enhance the continuity of care for Molina members.

Facilitates interdisciplinary care team meetings and informal ICT collaboration.

Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts.

Assesses for barriers to care, provides care coordination and assistance to member to address concerns.

25- 40% local travel required.

RNs provide consultation, recommendations and education as appropriate to non-RN case managers.

RNs are assigned cases with members who have complex medical conditions and medication regimens

RNs conduct medication reconciliation when needed.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing. Bachelor’s Degree in Nursing preferred.

Required Experience

1-3 years in case management, disease management, managed care or medical or behavioral health settings.

Required License, Certification, Association

Active, unrestricted State Registered Nursing (RN) license in good standing.

Must have valid driver’s license with good driving record and be able to drive within applicable state or locality with reliable transportation.

Preferred Education

Bachelor’s Degree in Nursing

Preferred Experience

3-5 years in case management, disease management, managed care or medical or behavioral health settings.

Preferred License, Certification, Association

Active, unrestricted Certified Case Manager (CCM)

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Clipped from: https://www.ziprecruiter.com/c/CVS-Health/Job/Medicaid-Proposal-Director-Work-from-home/-in-Phoenix,AZ?jid=b43db2962c1fa496&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Job Description
This is a remote position that can sit anywhere in the United States.

Aetna’s Medicaid Proposal Director / Lead Director Project Program Manager leads end-to-end pre-RFP and RFP activities for complex Medicaid proposals. The Proposal Director ensures high engagement and collaboration across the enterprise and external consultant resources, ensuring a fully compliant submission. The Proposal Director works with senior leaders to establish the vision for the proposal package and then coordinates with internal proposal team members to ensure its execution. The Proposal Director is responsible for following established processes, using established tools, influencing the proposal-specific strategy, and ensuring a high-quality product by reviewing and commenting on color team drafts.

The right candidate for this role will demonstrate the following aptitudes:
– Relationship building with fellow colleagues from the executive suite to individual contributors
– Effective communication approach that informs and aligns team members around a common vision
– Curious, self-motivated problem solver
– Demonstrated facilitation skills with a focus on expectation setting and adaptability to changing needs
– Efficiency focused to achieve maximum output with minimum resources
– Willingness to work nights and weekends during active proposal development timeframes as necessary to meet deadlines

Pay Range
The typical pay range for this role is:
Minimum: 100,000
Maximum: 221,000

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications
Required qualifications:

** 5+ years of experience managing Medicaid managed care proposals**

– Proven group presentation and facilitation skills

– Strong project management, planning, and coordination skills

– Ability to support the complex and varied needs of multiple senior leaders

– Strong written and verbal communication skills

– Ability to work independently to produce high quality results that meet needs of internal and external customer expectations under tight timeframes

– Strong team collaboration skills, including SMEs and other contributors, writing team, and production team

– Ability to adapt to rapidly changing priorities through the identification and execution on creative solutions

– Able to work evenings and weekends as proposal schedule requires

– Ability to travel 15%

COVID Requirements

COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

Preferred Qualifications
– Experience using a variety of electronic collaboration tools
– Experience developing competitive analyses
– Developing executive presentation decks
– Managed care operations experience

Education
– Bachelor’s degree or equivalent experience

Business Overview
Bring your heart to CVS Health
Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Clipped from: https://www.linkedin.com/jobs/view/management-consultant-iv-v-medicaid-us-at-public-knowledge%C2%AE-3315542939/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Applicants must be willing to travel and should be within an hour of a major airport.


Company Summary


Public Knowledge® is a national management consulting firm that helps government agencies solve tough problems and thrive in complex environments. We do this by providing planning, procurement, and implementation services. Most of our work is in Health and Human Services. You can learn more about us at www.pubknow.com.


Inclusion is a core value of Public Knowledge®. We value and seek to create a more diverse workforce. We encourage women, minorities, veterans, people with disabilities, people with different sexual orientations, people with lived expertise, and other diverse people to apply. We believe every member on our team enriches our diversity by exposing us to a broad range of ways to understand and engage with the world, identify challenges, and to discover, design, and deliver solutions. We are committed to creating a safe and inclusive workplace that highlights the diversity in all of us and our experiences.


Position Summary


This management consultant would spearhead research efforts to gather information for large projects and programs and propose creative solutions. This person would collaborate with project managers and team members to support project administration, time management, and budgeting.


Duties & Responsibilities Include, But Not Limited To


Research
 

• Gather information for a project by conducting interviews, surveys, facilitating groups, analyzing client documentation, conducting research of best practice and academic literature, and the application of other information gathering tools.
   
  

Project Support
 

• Learn and apply the tools and techniques we have for projects.
  
• Work with project managers to support the administration of projects (ensure staff adhere to standards, organizing the time of other team members, supporting project meetings, and assisting with project financial management).
  
• Help your team meet project objectives, timelines, and deliverables within budget.
   
  

Analysis, Communication, and Consultation
 

• Using your experience and research results, analyze and organize information identifying root causes of issues, opportunities for improvement, and generate ideas to improve the client situation.
  
• Based on your analysis, research, and experience participate with your team in the development of recommendations for actions that will improve the client situation.
  
• Communicate the results of our work (information, analysis, and recommendations) through the participation in the development and delivery of written reports, formal presentations, and oral discussions with your team, and as requested clients and stakeholders.
   
  

Firm Knowledge Sharing and Growth
 

• Freely share your knowledge, skills, and abilities with your peers in the firm.
  
• Perform firm administrative activities (maintain your resume, record your time accurately).
  
• Grow your skills and experience by participating in projects and actively pursuing continuing professional education.
  
• Develop an effective working relationship with clients and colleagues.
   
  

Required Education And Other Credentials

• Bachelor’s Degree required
  
• Valid Driver’s License
  
• PMP certification is strongly preferred
   
  

Required Experience And Skills

• At least three (3) years of project management experience, preferably in major IT systems-related work.
  
• At least three (3) years of experience conducting IV&V work, preferably in health or major IT systems-related work.
  
• Experience in systems development best practices and knowledge of the typical artifacts created as part of a system development project is required. Knowledge of Medicaid and or Integrated Eligibility is a requirement and familiarity with MITA. Knowledge of multi-project integration programs and multi-system data consolidation efforts is preferred.
  
• Knowledge of the components of Software Development Life Cycle and best practices including all waterfall and agile frameworks as well as SaaS, COTS, and Custom design solutions
  
• Deep knowledge of Medicaid and Health IT that spans the development and testing of systems through the operation of the programs the technology supports
  
• Proven ability to report observations, conclusions, and making recommendations for improvement about project problems and issues; ability to focus and to be objective on the assessment of SDLC processes and products
  
• Must have experience in bringing focus and organization to ambiguous situations
  
• Must demonstrate creative and strong analytical and problem-solving skills
  
• Demonstrates excellent interpersonal skills Must have flexibility and ability to adapt quickly to new situations
  
• Must have ability to establish and cultivate strong work relationships
  
• Must have clear, concise written and verbal communication
  
• Must have demonstrated life-long learning skills
  
• Desire to work in a collaborative, fast-paced, entrepreneurial environment
  
• Ability and willingness to travel (reasonable travel will be required)
  
• Proficient knowledge of Microsoft Word, Excel, and Outlook
  
• Must have excellent oral and written communication skills, including the ability to communicate with officials at all levels in government and industry
  
• Must have the ability to handle and organize multiple projects and deadlines
  
• Must demonstrate a high degree of attention to quality, details, and correctness
  
• Ability to work with colleagues in a virtual environment (via conference calls, web meetings, and using digital collaboration tools such as Zoom and cloud document repository)
   
  

Physical Requirements And Working Conditions

• Must have the ability to travel to client sites
  
• Ability to work from a home-based office
  
• Must have the ability to work at a computer for extensive periods of time
  
• Must have the ability to speak on the telephone for extended periods of time
  
• Must have the ability to read (paper or computer screen) for extended periods of time
  
• Must have sufficient hand, arm, and finger dexterity to operate a computer keyboard and other Company equipment
  
• Must have the ability to be self-driven, work independently and as part of a team
   
  

We Offer Excellent Benefits That Include

• Comprehensive Health and Dental Insurance
  
• Retirement Plan
  
• Disability Benefits
  
• Flexible Work Hours
  
• Generous Vacation Program
  

*If you are a Colorado resident, you may be eligible to receive additional information about the compensation and benefits for this role, which we will provide upon request. You may contact 732-942-3999 ext. 1436 for assistance


In accordance with PK’s duty to provide and maintain a safe workplace during the pandemic, we require all new employees to be fully vaccinated with a Coronavirus vaccine. You will be asked to show proof of vaccination prior to your start date

Apply Now

Clipped from: https://jooble.org/jdp/7877374904062009883/Health-Equity-Director-+-WV-Medicaid-Job-South-Carolina-South-Carolina?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

LOCATION:

This is a remote from home position with occasional visits to the Charleston office. You must be a resident of WV or be willing to relocate.

.

HOURS:

General business hours, Monday through Friday.

.

TRAVEL:

Approximately 25% travel is required throughout the state, and occasional national travel may be required.

.

This is a very strategic position that is responsible for assisting the state Health Plan community and stakeholder engagement experience, while applying application of science-based quality improvement methods to reduce health disparities.

 

.

 

Primary duties may include, but are not limited to:

 

• Assist with the strategic design, implementation, and evaluation of health equity efforts in the context of the population health initiatives.
  
• Inform decision-making around best payer practices related to disparity reductions, including the provision of health equity and social determinant of health resources and research to leadership and programmatic areas.
  
• Inform decision-making regarding best payer practices related to disparity reductions, including providing Health Plan teams with relevant and applicable resources and research and ensuring that the perspectives of members with disparate outcomes are incorporated into the tailoring of intervention strategies.
  
• Collaborate with the Health Plan analytics team to ensure the Health Plan collects and meaningfully uses race, ethnicity, and language data to identify disparities.
  
• Coordinate and collaborate with members, providers, local and state government, community-based organizations, and other entities to impact health disparities at a population level; and ensure that efforts addressed at improving health equity, reducing disparities, and improving cultural competence are designed collaboratively with other entities to have a collective impact for the population.
  

.

Required Qualifications
 

• Requires a BA/BS degree; ination of education and experience, which would provide an equivalent background.
  
• 5+ years of experience, in public health, social/human services, social work, public policy, health care, education, community development, or justice.
  

.

Preferred

Qualifications

• MPH or higher is strongly preferred.
  
• A background working in public health is strongly preferred.
  
• The ability to speak publicly and host a conversation is a must!
  
• Previous social service experience/Medicaid familiarity is very helpful.
  
• Previous leadership skills, either as a project manager or people leader, is preferred.
  
• Ability to work with cross-functional teams is extremely important.
  

Clipped from: https://molina-healthcare.talentify.io/job/director-medicaid-enrollment-remote-long-bch-california-molina-healthcare-2016368?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Job Description

Job Summary
Responsible for preparation, processing and maintenance of new members and re-enrollment. Processes and maintains health plan’s member and enrollment records, employer’s monthly reports, sending membership cards and materials. Verify enrollment status, make changes to records, research and resolve enrollment system rejections. Address a variety of enrollment questions or concerns received via claims, call tracking, or e-mail. Maintain records in the enrollment database.

Work Location – Remote, within the United States of America

Knowledge/Skills/Abilities

• Holds general oversight of enrollment and premium staff at each plan site within defined region. This may include employee reviews, coaching sessions and disciplinary actions.
• Monitors and enforces compliance with company-wide reconciliation processes.
• Ensures that delivery of enrollment / premium related data is accurate for defined region.
• Subject matter expert for projects and / or new business related to areas of oversight.
• Oversees maintenance of policies and standard operating procedures..


Required Education
Graduate Degree or equivalent combination of education and experience

Required Experience

7-9 years

Preferred Experience

10+ years


To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.


Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Clipped from: https://jobs.myflorida.com/Agency%20for%20Persons%20with%20D/job/MIAMI-MEDICAID-WAIVER-LIAISON-67073542-1-1-FL-33128/942052700/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website.

Requisition No: 752121 

Agency: Agency for Persons with Disabilities

Working Title: MEDICAID WAIVER LIAISON – 67073542 1 1

Position Number: 67073542 

Salary:  $34,091.20- $35,925.24 Annually 

Posting Closing Date: 10/30/2022 

MEDICAID WAIVER LIAISON – CS

AGENCY FOR PERSONS WITH DISABILITIES

SOUTHERN REGION – 67073542 – MIAMI, FL

***OPEN COMPETITIVE OPPORTUNITY***

“This advertisement will be used to fill multiple positions”

 
 

 
 

THIS IS A CAREER SERVICE POSITION

The Agency for Persons with Disabilities works in partnership with local communities to support people with developmental disabilities in living, learning, and working in their communities. APD provides critical services and supports for customers with developmental disabilities to reach their full potential. The Agency serves people with spina bifida, autism, Down syndrome, children age 3-5 at high risk of developmental disabilities, cerebral palsy, Prader-Willi syndrome, Phelan-McDermid syndrome, and intellectual disabilities. There is no charge or co-payment for services provided through the Agency.

www.apdcares.org

 
 

REQUIREMENTS

 
 

Open Competitive opportunity- Any applicant who meets the minimum requirements of the position.

 
 

Must have High School diploma or its equivalent.

 
 

Must have valid Florida Driver’s license.

 
 

Position may require some travel to surrounding areas, applicant must be willing and able to travel for work purposes.

 
 

**NOTE: Applicants must complete all fields in the Candidate Profile.  Work history with month, year, and hours worked are required to qualify for this position.  Responses to Qualifying Questions must be verifiable in the Candidate Profile. Resumes and other documentation can be attached to provide additional information. ***

 
 

DUTIES

 
 

Employees of the Agency for Persons with Disabilities are required to demonstrate total commitment to outstanding customer service.  This includes, but not limited to, acting in a responsive, professional, courteous manner with the employees, customers and public we serve at all times.

 
 

This is a professional position in the Medicaid waiver unit. This position has primary responsibility for conducting medical necessity reviews for individuals served through the Medicaid waiver program, processing cost plan amendment requests for increases in Medicaid waiver funding and in working with Medicaid waiver support coordinators.

 
 

Processes documentation for medical necessity reviews while ensuring the accuracy of the documents being submitted for assigned part of Medwaiver consumer case load. This includes, but is not limited to, the processing of annual Support Plans, PSA’s, Cost Plan adjustment requests and new waiver crisis enrollees. As directed by supervisor, assists with preparing for and attending due process hearings as the Agency representative.

 
 

Processes the Allocation Implementation Meeting (AIM) documentation for medical necessity while ensuring the accuracy of the documents for new waiver enrollees (Crisis and Waitlist to Waiver Transition).

 
 

Processes iBudget and iConnect requests as received from Waiver Support Coordinators and/or supervisor per case load assignment in a timely and accurate manner.  Checks iConnect/iBudget system daily and meets timelines for processing requests based on established policy and procedures.

 
 

Performs duties to support the Regional Medicaid Waiver Unit, including but not limited to, working with Medicaid waiver enrolled service providers, special assignments relating to changes in the Medicaid Waiver as needed.  Assists in the identification and resolution of Regional specific problems concerning policy implementation and service delivery.  Provides technical assistance regarding programmatic and consumer issues and assists in interpreting rules, policies and standards.

 
 

Processes CDC+ requests as received from Consultants and/or supervisor per case load assignment in a timely and accurate manner.  Checks and review CDC+ email inbox system daily and meets timelines for processing requests based on established policy and procedures.

 
 

Initiates and maintains open communication with community, service providers and stakeholders.  Assists, as assigned, with investigations of incidents and/or complaints regarding agency services providers.  Participates in workshops, training sessions and meetings as assigned.  Provides technical assistance
to Medicaid waiver providers
as needed/directed by the supervisor.

 
 

Provides iBudget and iConnect technical assistance to Waiver Support Coordinators, as necessary.

 
 

Assists with monitoring of consumer central files which are maintained by the Waiver Support Coordinators as directed by the supervisor.

 
 

Performs other duties as necessary to support the regional office functions, including but not limited to:  serving as back up staff for other Regional waiver staff and duties required during an emergency as specified in the Regional Emergency Management Plan.

 
 

KNOWLEDGE, SKILLS AND ABILITIES

 
 

• Must have experience in reviewing prior service authorization documents, support plans and/or cost plans.
  
• Must have experience working in a high demand work atmosphere while organizing/prioritizing your work assignments.
  
• Must have experience in providing technical assistance to ensure compliance with policies.
  
• Must be accurate in analyzing numbers as it relates to expenditures and budgets.
  
• Must have ability to read and interpret laws and regulations.
  
• Must have excellent ability to communicate orally and in writing, (face to face, electronically and/or written) information and ideas clearly, concisely, and effectively. 
  
• Must have knowledge and proficient use of Microsoft applications (Excel, Word, Power Point Share Point) and other required computer software applications.
  
• Ability to travel for work purposes
  

 
 

DIRECT DEPOSIT PROGRAM – As a condition of employment, a person appointed to a position in State government is required to participate in the Direct Deposit Program.  Rather than receiving a paper paycheck, your funds will be deposited directly into your account at your financial institution. This will be accomplished by Electronic Funds Transfer. Banks, savings and loan associations, and credit unions are eligible to accept such deposits. Retirement funds are also required to be in the Direct Deposit Program.

 
 

BACKGROUND SCREENING REQUIREMENT

It is the policy of the Florida Agency for Persons with Disabilities that applicants for employment undergo Level 2 employment screening in accordance with the requirements of Chapter 435, Florida Statutes, as a condition of employment or being permitted to serve as a volunteer.
No applicant for a designated position will be employed or permitted to volunteer until the Level 2 screening results are received, reviewed, and approved by the Agency.
Level 2 background screening shall include, but not be limited to, fingerprinting for Statewide criminal and juvenile records checks through the Florida Department of Law Enforcement, and Federal criminal records checks through the Federal Bureau of Investigation, and may include local criminal records checks through local law enforcement agencies.

 
 

THIS POSITION REQUIRES A BACKGROUND INVESTIGATION INCLUDING FINGERPRINTING, PURSUANT TO S. 110.1127(1), FLORIDA STATUTES.

WE HIRE ONLY U.S. CITIZENS AND THOSE LAWFULLY AUTHORIZED TO WORK IN THE U.S. APD PARTICIPATES IN THE U.S. GOVERNMENT’S EMPLOYMENT ELIGIBILITY VERIFICATION PROGRAM (E-VERIFY).  E-VERIFY IS A PROGRAM THAT ELECTRONICALLY CONFIRMS AN EMPLOYEE’S ELIGIBILITY TO WORK IN THE UNITED STATES AFTER COMPLETION OF THE EMPLOYMENT ELIGIBILITY VERIFICATION FORM (I-9).

ALL APPLICANTS SHOULD COMPLETE THE ON-LINE APPLICATION PROCESS.  IF ASSISTANCE IS NEEDED TO APPLY FOR THIS POSITION, PLEASE CALL THE PEOPLE FIRST SERVICE CENTER AT 1-877-562-7287. RESPONSES TO THE QUALIFYING QUESTIONS ARE REQUIRED TO BE CONSIDERED FOR THIS POSITION. ANSWERS TO THE QUALIFYING QUESTIONS MUST BE VERIFIABLE BASED ON YOUR SUBMITTED APPLICATION.

The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer, and does not tolerate discrimination or violence in the workplace.

Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (1-866-663-4735). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.

The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act.

VETERANS’ PREFERENCE.  Pursuant to Chapter 295, Florida Statutes, candidates eligible for Veterans’ Preference will receive preference in employment for Career Service vacancies and are encouraged to apply.  Certain service members may be eligible to receive waivers for postsecondary educational requirements.  Candidates claiming Veterans’ Preference must attach supporting documentation with each submission that includes character of service (for example, DD Form 214 Member Copy #4) along with any other documentation as required by Rule 55A-7, Florida Administrative Code.  Veterans’ Preference documentation requirements are available by clicking here.  All documentation is due by the close of the vacancy announcement. 

Clipped from: https://www.indeed.com/viewjob?jk=4287998af511b84f&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Benefits

Pulled from the full job description

Dental insurance

Vision insurance

West Orange Center is Hiring a Medical Records/Medicaid Specialist!!

Who We Are:

West Orange Center is a 120 Bed skilled facility located in Ocoee, FL. At West Orange Center for Nursing and Healing we pride ourselves on our exceptional employee culture and the high level of care we provide for our residents. We believe that the best way to maintain our high level of care is by having a great employee culture and by treating our staff with the same care and dedication we provide for our residents. We look forward to meeting you!

Essential Duties & Responsibilities of the Medical Records/Medicaid Specialist:

Medicaid Specialist:

Medicaid Specialist is responsible for assisting the BOM with completion and review of Medicaid Pending applications, to ensure all required documentation is made available and gathered for timely processing of the Medicaid application. Also responsible for submitting applications and follow through with the process for approval.

Medical Records:

Knowledge of medical terminology, Must be accurate and detailed oriented, Ability to work independently, Must be able to interact with customers, families, visitors, and center personnel.

• Maintain accurate order of charts, Answer Phones.
  
• Maintain HIPPA requirements regarding records, Prepare closed records, Filing current records, Maintain thin charts.
  
• Performs other duties as assigned.
  

Benefits:

• Competitive Pay
  
• Health Insurance
  
• Dental Insurance
  
• Vision Insurance
  

Clipped from: https://jobs.wjhl.com/jobs/medicaid-growth-leader-telecommute-in-va-norfolk-virginia/744396430-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

UnitedHealthcare is a company that’s on the rise. We’re expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn’t about another gadget, it’s about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life’s best work.(sm)


This position provides leadership for the Community and State Health Plans Medicaid products in their assigned market to support continued growth and innovation. The position is a member of the health plan senior leadership team and will work collaboratively with the CEO, COO and CFO to ensure overall strategies are aligned with the market level business objectives. This position will oversee the Medicaid community agenda and field-based outreach teams to develop market leading provider and community engagement to forge strong external relationships. This position is responsible for forecasting and has accountability in achieving growth (Acquisition and retention) targets. This is an external and internal facing role.

If you are located in the state of Virginia, you will have the flexibility to telecommute as you take on some tough challenges.You may work from your Virginia residence or in a Virginia office near you.

Primary Responsibilities:

• Develop and execute and continually update overall strategies for Medicaid product offering to maximize product growth, member retention, innovation and member and provider experience
  
• Drive smart Growth in membership and market share in designated market by developing solid relationships across segments and departments (Network, marketing, clinical, quality, finance)
  
• Lead, develop and uphold accountability of Medicaid products forecasting models with complete understanding of Auto assignment algorithms, eligibility requirements, self-select, and involuntary vs voluntary term ratios
  
• Manage local Medicaid field-based outreach teams and work directly with M&R regional sales leaders to leverage DSNP Outreach strategies and teams across segments
  
• Must be able to flex strategies to address local market nuances and unique requirements to assure that we are keeping healthcare “local” while maintaining a strong presence in the market
  
• Partner with local and functional teams to assure appropriate health plan benefit design and value-added services
  
• Formulate impactful relationships that drive engagement with community-based organizations and faith-based organizations
  
• Develop and implement provider engagement strategies (including Field-based approaches and face to face visits Providers) in partnership with Network partners that specifically focuses on membership growth and retention and making UHC the insurer of choice for UHC
  
• Lead and provide oversight for the Field community outreach team that orchestrates member events, potential consumer events, and community-based goodwill and general awareness that make UHC the insurer of choice
  
• Manage and uphold accountability for marketing, sponsorship and outreach budgets
  
• Represent the Health Plan at State meetings, community events, and media relations; Assist in developing new county expansions for existing Medicaid; Assist in implementing future product opportunities
  
• Ensure compliance to health plan State contract for MCO functions entailing Marketing, Communications, Engagement with Community Based Providers and Provider Network and outreach activities
  
• Lead and develop top field talent in designated markets, while creating bench strength and opportunities for professional growth within the team
  

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Bachelor’s degree
  
• 5+ years of people management experience
  
• Experience working in Managed Care
  
• Experience building analytical skills including generating ROI, business case forecasting and growth opportunities
  
• Proven track record developing and deploying market strategies
  
• Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation
  

Preferred Qualifcations:

• Master’s degree (MPA / MBA)
  
• Active health license
  
• Familiar with possible Medicaid referral sources (i.e. CBOs, providers, etc.)
  
• Bi-lingual
  

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That’s why you’ll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life’s best work.(sm)


All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.

 

Clipped from: https://www.adzuna.com/details/3580821067?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Location: Company:

 
 

Description

Humana Healthy Horizons in Ohio is seeking Managers of Care Management (Physical Health & Behavioral Health) who will lead our physical or behavioral health care management operations and staff to ensure timely and culturally-competent delivery of care, services, and supports in compliance with Ohio Department of Medicaid (ODM) contractual requirements and industry best practices.

Responsibilities

Essential Functions and Responsibilities:

• Supervise care management personnel and oversee all care management functions, including assessment, care planning, and care coordination.
  
• Lead development of care management policies and procedures to ensure compliance with state and federal requirements and incorporate industry best practices.
  
• Collaborate with internal departments, providers, and community partners to support the delivery of high-quality care management services, including introducing innovative approaches to care coordination.
  
• Oversee the processes for comprehensive enrollee assessments to identify their individual needs.
  
• Monitor and maintain staffing levels to meet care and service quality objectives.
  
• Support orientation and training of staff.
  
• Conduct timely evaluations of direct reports and provide regular opportunities for professional development.
  
• Influence and assist corporate leadership in strategic planning to improve effectiveness of case and disease management programs for physical health and behavioral health.
  
• Collect and analyze performance reports on care management functions to monitor adherence with benchmarks, identify opportunities for process improvement, and develop recommendations to leadership
  

Oversee Care Management staff to ensure the following:

• Utilize a holistic, enrollee-centric approach to engage and motivate enrollees and their families through recovery and health and wellness programs.
  
• Perform clinical intervention through the development of a care plan specific to each enrollee based on clinical judgement, changes in enrollees’ health or psychosocial wellness, and identified triggers.
  
• Communicate regularly with enrollees/families, physicians, and facilities/agencies to assure optimal quality patient care and effective operations.
  
• Collaborate with relevant internal and external partners to coordinate seamless transitions for enrollees from inpatient settings to community-based services.
  

Required Qualifications

• Must reside in the state of Ohio.
  
• Licensed Registered Nurse (RN) or Licensed Behavioral Health Professional (LSW, LISW, LISW-S, LPC, LPCC or LPCC- S) in the state of Ohio, with no disciplinary action.
  
• Minimum Five (5) years’ experience working in the healthcare setting.
  
• Minimum two (2) years of management/supervisory experience.
  
• Experience in physical health case management or behavioral health case management.
  
• For Behavioral Health, C.M. Manager Only: Must have a Child and Adolescent Needs & Strengths (CANS) certification or able to obtain one within 60 days of hire.
  
• Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook.
  
• Ability to work independently under general instructions and with a team.
  
• This role is considered patient facing and is a part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
  
• This role is part of Humana’s Driver safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.
  
• Must have the ability to provide a high-speed DSL or cable modem for a home office.
  
• A minimum standard speed for optimal performance of 25×10 (25mpbs download x 10mpbs upload) is required.
  
• Satellite and Wireless Internet service is NOT allowed for this role.
  
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
  
• Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.
  

Preferred Qualifications

• Bachelor’s degree in nursing, health administration, or related field.
  
• Certified Case Manager (CCM).
  
• Bilingual – Fluency in Spanish or Somali.
  
• Experience serving Medicaid, TANF, and/or CHIP populations.
  

Additional Information

• Typical Work Days/Hours: Monday – Friday; 8:00am – 5:00pm.
  
• Travel: Up to 25% in-state travel.
  
• Direct Reports: Up to 15 associates.
  

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40